Life is pretty good for Aurelia
N. At 50, this professional scuba diver no longer suffers
from decompression sickness after she went under the knife
to close the hole in her heart — a defect called
patent formen ovale (PFO). Miraculously, Aurelia's painful
migraines also disappeared postsurgery. Generally harmless,
PFO can cause decompression sickness in divers —
but is it linked to migraines? Many divers' attacks cleared
up following surgery, spawning the theory that the procedure
could be a cure for migraine.
TESTING
A CURE
The Migraine Intervention with STARFlex Technology (MIST)
trial plans to test this theory by using a catheter
device to close the PFOs of 100 migraine sufferers who
experience auras. A further 100 matched patients will
undergo sham surgery. The trial is set to begin this
year once enough participants have been recruited.
"While there are many migraine
treatments that help control symptoms, as yet there
is no cure," says lead researcher Dr Andrew Dowson,
of Kings College Hospital in London. "If the trial supports
our theories about a migraine-PFO link, it could be
the most significant development in treatment for over
a decade."
The word 'cure' isn't bandied about
lightly, especially at the outset of a trial, but the
specialists collaborating on MIST have good reason to
believe that they're on to something. The results seen
in divers have already been replicated in several studies
of patients whose PFOs were closed to reduce stroke
risk.
One of these studies, published
in the February 2003 issue of the Journal of Interventional
Cardiology found that patients who suffered migraines
with aura saw their headache scores fall by two-thirds
after closure. A second study in the April 2004 Neurology
found that PFO closure reduced attacks by more than
half in migraine sufferers both with and without aura.
Still, specialists agree that PFO is most strongly associated
with migraines accompanied by an aura.
If all of this is true, says MIST
researcher Dr Peter Wilmshurst of the Royal Shrewsbury
Hospital, UK, it could raise hackles in the neurology
community, which holds quite different theories about
the causes of migraine. The next three years should
reveal whether cardiologists or neurologists are better
suited to treating migraine patients.
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